Questioning ART

With a new-found desire to become a mother and her 41st birthday approaching, Miriam Zoll and her husband did what many older would-be parents do: they made an appointment at a fertility clinic.

Almost a year earlier, on that most emblematically charged of days—her 40th birthday—Zoll had woken up with a sudden determination to become pregnant. But after a year of trying unsuccessfully the “old-fashioned way,” and conscious of the passing of time, the couple, who live in the Valley, headed to a well-regarded clinic in Boston. Generally holistic and low-key in their approach to medicine—“choosing old-fashioned remedies over pharmaceuticals on most occasions,” as Zoll puts it—they were dubious about the high-tech path they were about to embark on, but also optimistic.

As Zoll writes in her new memoir, Cracked Open: Liberty, Fertility, and the Pursuit of High-Tech Babies (published by Northampton’s Interlink Books), that optimism was common among members of what she calls the “Late Bloomer Generation,” who were confident that bearing children could be deferred until after the career successes and other kinds of personal fulfillment the women’s movement offered them. “We are the generation that … came of age at a time of burgeoning reproductive technologies,” she writes. “We grew up with dazzling front-page stories heralding the marvels of test-tube babies, frozen sperm, and egg donors; stories that helped paint the illusion that we could forget about our biological clocks and have a happy family life after—not necessarily before or during—the workplace promotions.”

But in her case, that optimism was heartbreakingly unwarranted. Zoll’s first round of ART treatment (that’s “assisted reproductive technology,” for the uninitiated) did not lead to pregnancy. Instead, it was just the first of a series of increasingly expensive, invasive, emotionally draining—and, worst of all, ineffective—steps the couple took in their quest to become parents.

The process left Zoll deeply cynical about the “marvels” of assisted reproduction and eager to correct the deep misperceptions held by many couples and what she considers outright subterfuge on the part of the medical industry. If most couples really knew how slim their odds of success were, she writes, “they would never set foot in an IVF clinic. But the fertility industry sells hope to couples distraught over their inability to produce offspring, and hope is a multi-billion-dollar business.”

Zoll’s birthday-morning decision to become a mom was as surprising to her as to those who knew her. She had spent her adult life focused on a rewarding but demanding career in the human-rights field, putting in long hours, traveling the globe, sometimes landing in dicey situations. As a young woman, she writes, “Instead of looking for someone to marry and have kids with someone—something, by the way, that the majority of my women friends never thought of either—I set off on a path of proving myself in Manhattan. Like millions of other young American women just starting their careers, paying off student loans, and developing their confidence, I did everything I could to avoid motherhood.”

Zoll’s personal life, meanwhile, was equally unsettled, if exhilarating, perhaps most explicitly in her years-long, on-and-off relationship, filled with betrayals and extended separations and much, much drama, with Michael, the man who would eventually become her husband. Then there was her own childhood, in a household with a domineering and mercurial father and a mother whose acceptance of the passive, traditional housewife role was a stark contrast to the burgeoning second-wave feminism that the young Zoll saw all around her, and no doubt led to the daughter’s determination to live a very different kind of life. There were other family problems as well: Zoll’s bout with bulimia, which she kept hidden from her parents; her sister’s diagnosis with cancer at a young age; her brother’s imprisonment on a drug conviction and his ongoing substance abuse problems.

But by the time she turned 40, Zoll and Michael had been happily married for five years, with a dog and an old farmhouse in the Valley and a desire to begin a new phase of their lives, as parents. That phase began with Zoll taking a series of pricey hormone injections, then having five eggs “harvested” from her ovaries (she writes that she was “a little taken aback” by that term, with its evocations of poultry farms and fish hatcheries). The eggs were then married with her husband’s sperm and implanted in her womb at a hormonally determined optimal time.

Two weeks later, Zoll’s pregnancy test came back negative. “We were shocked,” she writes. “We had been absolutely convinced it was going to work. Until this point we had both assumed that other people had trouble getting pregnant, but us—well, we were something special. We were supposed to get pregnant on the first ART and then send the doctors on their way.”

That rude awakening—the realization that they were like the tens of thousands of couples who turn to ART in the U.S. every year—was followed by years of hormone pills and injections, invasive medical procedures and one pregnancy that resulted, devastatingly, in miscarriage.

When a doctor told Zoll her eggs are no longer viable, she and Michael turned, with great ambivalence, to donor eggs. Scrolling through a website of potential donors, model-beautiful young women whose eggs came with $8,000 and $10,000 price tags, Zoll found herself wondering why, exactly, they were referred to as “donors,” and pondering uneasy questions about the commodification of a woman’s fertility, with some women’s eggs commanding more based on their ethnic background or the prestige of their alma mater. The couple gave up on using donated eggs after two failed attempts; in both cases, ironically, the donors were, apparently, infertile.

As she moved through the process, Zoll was like a raw nerve, her concerted efforts to maintain some sort of equilibrium—she practiced yoga and sought out healing therapy—not enough to counter the frustrations and disappointments that pressed on her. She suffered from insomnia and anxiety, and her marriage was strained as she and Michael struggled with all that was happening to them—and not happening.

Zoll’s journey was marked with grief, helplessness and, perhaps most palpably, anger. In some cases, that anger was directed at individual healthcare providers whose bluntness or momentary insensitivity cut Zoll in ways they could not have intended.

More broadly, through, Zoll was angry at the larger “fertility industry,” which she believes feeds would-parents false hopes and an increasingly pricey menu of reproductive technologies. She writes of her frustration with the media’s love of stories of women, both celebrities and ordinary women, giving birth as they near their 45th, even 50th, birthdays. She points to the problems created when technological advances in the area of fertility outpace ethical considerations about their greater implications.

Most of all, she writes of the personal agony she felt as she wrestled with feelings of self doubt, guilt and powerlessness: “Fertility treatments taught me to see life as a board game. External rules were imposed. A certain amount of money was involved. I was told to advance. I was told to retreat. Sometimes it felt like I was winning. Most of the time it felt like I was losing. Without the proper mindset I might fall off the board game altogether, end up in the river without a paddle, even drown when no one was looking.

“It felt like a form of psychological torture. At night I would lie awake and replay the what-ifs and the should-haves of my life so far. I knew this game of replay was a sure sign that my youth was fading. I had never had regrets about my life until now.”

Ultimately, Zoll and Michael decided to try adoption. This, too, was not an easy route, in part because they couldn’t help but carry their cynicism about the fertility industry with them as they entered the world of adoption, a process that, once again, left them aware just how little control they had over their fate.

Readers who plan to read Zoll’s book and who enjoy suspense, stop here; readers who crave relief will be satisfied to know that, at age 46, after seven years trying to conceive and seven months waiting to be chosen by a birth mother, Zoll get her long-awaited baby, a beloved little boy she and Michael named Sammy.

It’s a happy ending, but after her years of struggle, Zoll is not about to romanticize her experience. In her book’s afterword, she writes about research that looks at post-traumatic stress disorder in women who’ve undergone unsuccessful fertility treatments. The study, she writes, “confirmed to me that, just because the doctor appointments, the injections, the egg transfers, and the dashed hopes are over, it does not mean the trauma is over. The sense of violation that many women say they still feel years later, coupled with the deep, deep sadness of not having borne a child, lingers in our lives like a persistent mosquito buzzing in a dark room. Even when you don’t hear it you know it is there, waiting to sting you, and it does.”•